OKOJ, Volume 5, No. 3

Instability of the lesser metatarsophalangeal (MTP) joints is a common problem that may occur with synovitis, systemic arthritis, and trauma. MTP joint instability is generally manifested clinically as an ill-defined forefoot pain that can be mistaken as neuritic in origin. Conservative treatment is recommended initially and consists of wearing shoes with roomy toe box areas to accommodate the toes and metatarsal pads to help reduce the pressure under the MTP joint and reduce the synovitis. Surgical treatment is determined by the magnitude of the deformity and its rigidity. For flexible, reducible deformities, the author recommends a metatarsal-shortening Weil osteotomy, following tenotomy and dorsal capsulotomy, to shorten the collateral ligaments and reduce the MTP joint. For fixed, dislocated deformities, an extensive release of the dorsal, medial, or lateral structures should be performed, followed by a Weil osteotomy. Reefing of the elongated structures should complete the correction, and a tendon transfer should be added to aid in the stability of the joint.

Osteoarthritis of the thumb trapeziometacarpal (TM) joint due to degeneration of the anterior oblique "beak" ligament results in pathologic laxity, abnormal translation of the metacarpal on the trapezium, and generation of excessive shear forces between the joint surfaces during grip and pinch activity. This article describes our rationale for performing ligament reconstruction and trapezium excision (LRTI arthroplasty) in the treatment of thumb basal joint arthritis. Surgical procedure steps are detailed, and normal TM joint anatomy and biomechanics, as well as pathoanatomy, are also presented to provide a better understanding of this region of the hand.

Localized antibiotic therapy using antibiotic-impregnated bone cement has become an attractive option for treating severe orthopaedic infections. In the form of beads and spacers, antibiotic-impregnated cement can provide high concentrations of local antibiotic to a wound with minimal systemic toxic exposure. Clinical uses of antibiotic beads and spacers include prophylaxis for open fractures and total joint arthroplasties and in the treatment of acute and chronic osteomyelitis. Limited clinical data indicate that the use of antibiotic beads decreases the incidence of adverse effects observed with systemic antibacterial therapy. A detailed description of the"bead pouch"technique for the prevention of infection in open fractures is provided in this article.

Reverse total shoulder arthroplasty is a unique surgical solution for patients with pain and dysfunction from advanced glenohumeral joint arthritis associated with severe rotator cuff deficiency. In the normal shoulder, the rotator cuff and deltoid muscles work together to elevate the arm. However, with massive rotator cuff tears and advanced degenerative joint disease, the normal mechanics of the shoulder are disrupted, making arm elevation difficult if not impossible. The reverse shoulder prosthesis corrects this by providing a fixed fulcrum for the shoulder joint that allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm. Reverse total shoulder arthroplasty is still in its infancy, and a number of issues have yet to be resolved with this procedure; however, with thorough patient evaluation and careful patient selection, complications can be minimized, and satisfactory pain relief and increased range of motion can be achieved in most patients.

A practicing orthopaedic surgeon should acknowledge the risk of venous thromboembolic disease (VTED) following orthopaedic surgical procedures on the lower extremity. Specifically, patients undergoing total hip arthroplasty or total knee arthroplasty and patients with complex trauma appear to be at particular risk. The recommendation of the Seventh American College of Chest Physicians (ACCP) Conference on Antithrombotic and Thrombolytic Therapy are discussed for patients undergoing total hip replacement, total knee replacement, hip fracture surgery, knee arthropscopy, elective spine surgery, and surgical treatment of lower extremity fractures distal to the femur.

Keywords:

deep vein thrombosis

DVT

pulmonary embolism

PE

pulmonary embolus

venous thromboembolism

venous thrombosis

lower extremity thrombosis

leg thrombosis

incidence

etiology

prophylaxis

epidural anesthesia

diagnosis

venography

ultrasound

clinical signs

electrocardiogram

arterial blood gas

pulmonary angiogram

ventilation-perfusion scan

spiral CT angiography

treatment

heparin

warfarin

THA

TKA

deep venous thrombosis

low-molecular-weight heparin

LMWH

ascending contrast venography

color Dopplar ultrasound

magnetic resonance venography

electrocardiography

arterial blood gas analysis

pulmonary angiography

V-Q scan

spiral computed tomography angiography

aspirin therapy

Subspecialty:

Trauma

Adult Reconstruction

Basic Science

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